住院患者导管相关性血流感染病原菌分布与耐药分析

The distribution and drug resistance of pathogens isolated from inpatients with catheter related blood stream infection

目的探讨住院患者血管导管相关性血流感染的病原菌分布及耐药情况,为医院感染的控制提供依据。方法对2011年1月至2012年2月住院患者中导管相关性血流感染病例的643株细菌的耐药性进行统计分析。结果导管相关性血流感染发生率为4.1%,其中多重耐药细菌感染发生率为3.0%,分离病原菌以革兰阴性杆菌为主,占55.4%,革兰阳性球菌占43.2%。革兰阴性杆菌以肺炎克雷伯菌、大肠埃希菌为主,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星耐药率低,鲍曼不动杆菌对亚胺培南耐药率增高;革兰阳性球菌以耐甲氧西林凝固酶阴性葡萄球菌为主,未出现耐万古霉素肠球菌。结论加强细菌耐药检测,合理使用抗菌药物,对减少医院导管相关性血流感染的发生和耐药菌株产生有重要意义。

Objective To discuss the distribution and drug resistance of pathogens isolated from catheter related blood stream infection（CRBSI）,and provide evidence for CRBSI diagnosis and treatment.Methods The statistical analysis was performed on 643 strains isolated from CRBSI patients from January 2011 to February 2012 in regards to their distribution and drug resistance.Results the incidence of CRBSI was 4.1% in hospitalized patients,among which the infection caused by multidrug resistant bacteria accounted for 3.0%.The pathogens were mainly consisted of Gram-negative bacilli（55.4%） and Gram-positive cocci（43.2%）.Klebsiella pneumoniae and Escherichia coli were the major Gram-negative bacilli,and showed a low drug resistance to cefoperazone/sulbactam,piperacillin/tazobactam and amikacin.The drug resistant rate of Acinetobacter baunammii to imipem was in an upward tendency.Methicillin-resistant coagulase negative Staphylococcus（MRCNS） was dominant in the Gram-positive cocci.No vancomycin-resistant Enterococcus was found.Conclusion The nosocomial CRBSIs and occurrence of resistant strains can be significantly reduced by strengthening the monitoring of drug tolerance and using antibiotics reasonably.